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If you were the parent of a baby boy and were told a minor operation could provide him with protection against three diseases (at least) that kill millions worldwide, would you be interested? It is safe to assume that you would. When, however, you discovered that the operation in question was circumcision, would your enthusiasm dwindle?

Circumcision is the world's most common surgical procedure. But it is also among the most sensitive – politically, culturally and ethically. Even within the scientific community it is difficult to have a reasoned debate about the pros and cons, examining the evidence, without people taking sides. For several decades, the medical community has kept quiet about circumcision, mindful of the sensitivities around it. Doctors are broadly agreed that the operation is "not medically necessary" – except in a tiny minority of cases, for example where the foreskin will not retract. They say it is for parents and the public to decide about the ethics of circumcision for religious or other non-medical reasons.

Now that cosy consensus has been challenged by the emergence of evidence showing that the removal of the foreskin can prevent a number of sexually transmitted diseases. Three landmark randomised controlled trials conducted in South Africa, Kenya and Uganda between 2005 and 2007 demonstrated that adult male circumcision reduced the risk of contracting HIV by 50 to 60 per cent. This is well known and has led to the development of programmes offering circumcision in a number of African countries, backed by the World Health Organisation, with predictions that in the long term it could save millions of lives.

Now new evidence has emerged for the protective effect of circumcision against infection with Human Papilloma Virus (HPV), the chief cause of cervical cancer in women, which is reduced by 35 per cent, and against Herpes Simplex Virus (HSV), the cause of herpes, which is reduced by 25 per cent. Circumcision probably also protects against syphilis, but the findings, published in the New England Journal of Medicine in March, were based on too small a sample to be conclusive.

Both HPV and HSV are global health problems that far outstrip HIV in frequency, causing substantial death and suffering. Cervical cancer is responsible for thousands of deaths in western countries (and millions in the developing world). Herpes is seldom fatal, but it causes significant illness and costs millions of pounds to treat.

An editorial in the NEJM said that the findings were "a call to action for professional societies" to review the advice they give on circumcision. Two countries – the US and Australia – have already heeded the call. The American Academy of Paediatrics has established a taskforce to examine its policy on circumcision and a similar review is under way in Australia.

Susan Blank, chair of the US task force and a paediatrician with the New York City health department, says: "In the last few years a lot of data has come out that needs to be evaluated and policy developed. It is true that the data are compelling. Our task is to look at it in the context of our domestic situation. There are a lot of emotional overlays that go along with issues of babies and child health." Dr Blank says circumcision has been declining in some states in the US but the overall prevalence, at 65 per cent, remains high compared with the UK.

In the UK rates are much lower and have been falling for decades. They stand currently at 16 per cent, according to the Health Protection Agency (HPA). But the UK Royal College of Paediatrics has no plans to follow its sister organisations in the US and Australia by setting up a taskforce to review the evidence.

Could there be other factors at work here like poor willy hygiene / promiscuity etc.... ?

Surely the law of unintended consequences of this would be that men would feel that they could have unsafe sex because they are now invulnerable to diseases because the foreskin has been removed.

Have these studies been done in countries with high or low condom use?

Apparently we can't use the P word for willy????????? Why the censorship?

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The figures for infections are taken from third world nations whereby having a bath is the luxury of the elite. The way we are going its entirely feasible that the only people in the UK having a bath will be the Rt Hon Members of the Labour Party, but until that time its clear from the UK that Roundheads are just as susceptable to these diseases as Cavaliers.

Professor Terence Stephenson, president, says HIV is uncommon in the UK and there is little heterosexual transmission within the country, and no evidence that circumcision is protective in men who have sex with men. There is a vaccine available against cervical cancer currently being rolled out in a national campaign, which is expected to significantly reduce the toll from that disease and the incidence of herpes in the UK is substantially lower than in the US. "As a public health measure, I doubt if the college or the Department of Health would be pressing hard for the introduction of neonatal circumcision. To carry out 300,000 a year in the UK on the NHS [the annual number of male births] would be a huge cost – money which could be used for other things." If a parent asked for information about the benefits of circumcision, he would spell them out, he says. But there are drawbacks, too, including the discomfort caused by the procedure, the need for antibiotics and, rarely, complications such as bleeding. Barry Evans, consultant epidemiologist and specialist in sexually transmitted infections at the HPA says the value of circumcision as a defence against HIV in Africa is well established. "It is fantastic and has a real possibility of denting the Aids epidemic in Africa," he said. But in the West it is a different story. Debating the issue is difficult, however. There are entrenched views on both sides, he says . "Some people view it as tantamount to child abuse while others say that not to do it amounts to child neglect and that it should be regarded like vaccination. Very few say let's look at the evidence, weigh it up and decide if it is worthwhile."

There is a clear medical benefit to circumcision and if parents are considering the procedure for religious or other reasons, these should not be downplayed. But in terms of benefit to the population as a whole, the consensus in the UK is that efforts to increase the current rate would be hard to justify. It remains to be seen whether the US and Australia share that view.

In short, a cost/benefit analysis reveals no clearcut case for a mass circumcision programme.

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Exactly. The unneccessary sexual mutilation of children is barbaric and shouldn't be allowed.

-1

male circumcision != female circumcision

Its a hygiene issue nothing more especially when you consider some boys/blokes cant pull the foreskin back.

+1

I'm one of them - it's called phimosis, it's fairly common, but often not diagnosed until quite late (i.e. when the sufferer becomes sexually active). Needless to say, adolescent boys tend not to leap at the chance of surgery on their dicks and will generally work around the problem, at the cost of a full sex-life and dignity.

All I can say is that I'm glad we spotted the condition in my son and had him circumcised when he was two.

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All I can say is that I'm glad we spotted the condition in my son and had him circumcised when he was two.

Glad he was only two - young enough to forget about it, I hope.

When my daughter was having her tonsils out there was a poor little boy of about 4 or 5 on the same ward who'd just had the snip. He was constantly crying, 'My willy hurts!' and the main reaction of the nurses seemed to be amusement.

The figures for infections are taken from third world nations whereby having a bath is the luxury of the elite. The way we are going its entirely feasible that the only people in the UK having a bath will be the Rt Hon Members of the Labour Party, but until that time its clear from the UK that Roundheads are just as susceptable to these diseases as Cavaliers.

Is that the Order, Order of the Bath?

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When my daughter was having her tonsils out there was a poor little boy of about 4 or 5 on the same ward who'd just had the snip. He was constantly crying, 'My willy hurts!' and the main reaction of the nurses seemed to be amusement.

Had it done at age 10 for because my foreskin stopped retracting. Couldn't even let the bed clothes touch the bl00dy thing for the first week, f4cking agony!!! Was finally able to change out of my dressing gown and put my pants back on after 3 weeks!

Mind you, no problems in the bedroom department thanks to getting it sorted. Apparently it reduces sensitivity for men during sex, but hey, perhaps that's partially responsible for my legendary stamina, so no worries there

Wouldn't rely on it for safe sex though! Anyway, the last thing the world needs is more people or to encourage reckless people to breed, so mass programs like this are best left alone. As for a cure for cancer? Be the end of this planet IMO.

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When my daughter was having her tonsils out there was a poor little boy of about 4 or 5 on the same ward who'd just had the snip. He was constantly crying, 'My willy hurts!' and the main reaction of the nurses seemed to be amusement.

Heh - can't say I was laughing after my son's op. I vaguely imagined that it would be a fairly neat affair. He didn't seem to mind, but it looked like it had been chewed by a dog. He showed his dick to his gran when he got back from the hospital and she nearly fainted.

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He was constantly crying, 'My willy hurts!' and the main reaction of the nurses seemed to be amusement.

In that case they were poorly trained or should never have got the job in the first place. Having a giggle when you're behind closed doors in the staff coffee room is one thing, but doing so in front of the patient is completely unprofessional.

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Hasn't it been standard for circumcision in the US for a quite some time now anyway? Heard phone-ins about it when I was in the US - and, if the incidence of herpes is higher in the US that sort of blows that argument out of the water.

Agree that the idea that "I'm safe" could lead to more risky behaviour.

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My brother in law is going for his third circumcision next week. Yes, that's right, THE THIRD TIME.

First time he was seventeen and paid his Local GP as private practice to do it at the local surgery.

The GP wasn't particularly adept at surgery, botched it up and left him sort of half done.

Second time he went back six months later to the same GP to get it sorted out, fully done now, but with so much scarring that it apparently looks a bit like an overcooked cheap plastic skin sausage, you know the kind where the skin shrinks and the end pops out.

He was young and made a mistake going to his GP to get it done, an even bigger mistake to go back again.

Now ten years later I think he's going private again to get it sorted, hopefully by someone qualified.

To anyone thinking it's just a simple snip, think again and make sure you know the surgeon is fully experienced in this sort of op.

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Could there be other factors at work here like poor ***** hygiene / promiscuity etc.... ?

Surely the law of unintended consequences of this would be that men would feel that they could have unsafe sex because they are now invulnerable to diseases because the foreskin has been removed.

Have these studies been done in countries with high or low condom use?

If you follow this logic then seatbelts and airbags should be banned because they lull you into a false sense of security. I had to have this op done at 49 because of a condition called balanitis whereby the skin loses the ability to stretch.Having been both circumcised and uncircumcised I can state that it's better to be without the foreskin for many reasons.